Prospective replication study implicates the catechol-O-methyltransferase Val158Met polymorphism as a biomarker for the response to morphine in patients with cancer

Novel single nucleotide polymorphism biomarkers to predict opioid effects for cancer pain

There have been few studies on predictive biomarkers that may be useful to select the most suitable opioids to optimize therapeutic efficacy in individual patients with cancer pain. We recently investigated the efficacy of morphine and oxycodone using single nucleotide polymorphisms (SNPs) of the catechol-O-methyltransferase (COMT) rs4680 gene as a biomarker (RELIEF study). To explore additional biomarkers that may enable the selection of an appropriate opioid for individual patients with cancer pain, three SNPs were examined: C-C motif chemokine ligand 11 (CCL11; rs17809012), histamine N-methyltransferase (HNMT; rs1050891) and transient receptor potential V1 (TRPV1; rs222749), which were screened from 74 pain-related SNPs. These SNPs, which were identified as being significantly associated with the analgesic effect of morphine, were then used to genotype the 135 patients in the RELIEF study who had been randomized into a morphine group (n=69) or an oxycodone group (n=66). The present study then assessed whether the SNPs could also be used as selective biomarkers to predict which opioid(s) might be the most suitable to provide pain relief for patients with cancer. Oxycodone tended to provide superior analgesic effects over morphine in patients carrying the genotype AA for the CCL11 rs17809012 SNP (P=0.012 for interaction), suggesting that it could serve as a potential biomarker for personalized analgesic therapy for patients suffering with cancer pain.

Genetic risk factors for chronic postsurgical pain in children: A narrative review

Genetic risk factors for chronic postsurgical pain in adults have been established, but little is known whether the same associations exist in children. It is even less clear how much influence single nucleotide polymorphisms can exert on the phenotypic expression of chronic postsurgical pain in children in general. To this effect, a search was made for original articles which met the following criteria: evaluation of postsurgical pain in children with known genetic mutations or, conversely, evaluation of atypical pain trajectories of postsurgical children assessing for possible genetic mutations that may explain the phenotype. All titles and abstracts retrieved were reviewed for suitability for inclusion. The references of the selected articles were also checked for additional relevant papers. To assess the transparency and quality of the genetic studies both STrengthening the REporting of Genetic Association studies scores and Q-Genie scores were applied. Overall, there is a paucity of information regarding the link between genetic mutations and eventual chronic postsurgical pain development although there is some information on acute postoperative pain. Evidence has shown that the contribution of genetic risk factors to chronic postsurgical pain development appears to be minor, with its clinical relevance yet to be described. More advanced techniques in systems biology (proteomics, transcriptomics) suggest promising avenues for investigating the disease.

Morphine Versus Oxycodone for Cancer Pain Using a Catechol-O-methyltransferase Genotype Biomarker: A Multicenter, Randomized, Open-Label, Phase III Clinical Trial (RELIEF Study)

BACKGROUND

We hypothesized that the high-dose opioid requirement in patients carrying the rs4680-GG variant in the COMT gene encoding catechol-O-methyltransferase would be greater for patients taking morphine than for those taking oxycodone, thus providing a much-needed biomarker to inform opioid selection for cancer pain.

METHODS

A randomized, multicenter, open-label trial was conducted at a Japanese hospital's palliative care service. Patients with cancer pain treated with regular doses of nonsteroidal anti-inflammatory drugs or acetaminophen were enrolled and randomized (1:1) into morphine (group M) and oxycodone (group O) groups. The minimum standard dose of immediate-release (IR) oral opioids was repeatedly administered by palliative care physicians to achieve pain-reduction goals (Pain reduction ≥ 33% from baseline and up to ≤ 3 on a numerical rating scale). The primary endpoint was the proportion of subjects requiring high-dose opioids on day 0 with the GG genotype.

RESULTS

Of 140 participants who developed cancer-related pain among 378 subjects registered and pre-screened for the genotype, 139 were evaluated in the current study. Among patients carrying a COMT rs4680-GG genotype, 48.3% required high-dose opioids in group M, compared with the 20.0% in group O (95% CI, 3.7%-50.8%; P = .029). Of those with the non-GG genotype, 41.5% treated with morphine and 23.1% with oxycodone required high-dose opioids (95% CI, 3.3%-38.3%; P = 0.098).

CONCLUSION

Using the COMT rs4680 genotype alone is not recommended for selecting between morphine and oxycodone for pain relief.

Correlation between Oral Thiamine as an Opioid Adjuvant and Cathecol-O-Methyltransferase Enzyme Levels in Cervical Cancer Patients

BACKGROUND: The high prevalence of cancer pain shows that a lot of the patients are undertreatment. Vitamin B is one of the additional alternative substances studied in cancer pain management. Thiamine is believed to modulate pain mechanisms in lowering the Cathecol-O-Methyltransferase (COMT) enzyme level. AIM: The aim of the study was to assess the correlation between Oral Thiamine as an Opioid Adjuvant and COMT Enzyme Levels in Cervical Cancer Patients METHODS: This research is a quasi-experimental study with a pre-test and post-test control group design. Patients in this study were 32 cervical cancer patients who experienced cancer pain, divided into two groups (treatment and control groups). The treatment group received morphine plus thiamine 500 mg/8 h/oral, and the control group received morphine alone. Measurement and evaluation of pain scores were carried out after 72 h of thiamine administration and blood collection was carried out again 4 h after the last thiamine administration to check thiamine levels and COMT. Then, data collection and analysis is being evaluated. RESULTS: From 32 cervical cancer patients studied, there were differences in changes in numeric rating scale (NRS) levels and COMT levels in the thiamine treatment group. CONCLUSIONS: The administration of thiamine can reduce COMT enzyme levels and clinically reduce NRS in cervical cancer patients. If it confirmed by other findings, thiamine might be considered for its use in the treatment of cancer pain.

Pharmacogenomics of Cancer Pain Treatment Outcomes in Asian Populations: A Review

In advanced cancer, pain is a poor prognostic factor, significantly impacting patients' quality of life. It has been shown that up to 30% of cancer patients in Southeast Asian countries may receive inadequate analgesia from opioid therapy. This significant under-management of cancer pain is largely due to the inter-individual variability in opioid dosage and relative efficacy of available opioids, leading to unpredictable clinical responses to opioid treatment. Single nucleotide polymorphisms (SNPs) cause the variability in opioid treatment outcomes, yet their association in Asian populations remains unclear. Therefore, this review aimed to evaluate the association of SNPs with variability in opioid treatment responses in Asian populations. A literature search was conducted in Medline and Embase databases and included primary studies investigating the association of SNPs in opioid treatment outcomes, namely pharmacokinetics, opioid dose requirements, and pain control among Asian cancer patients. The results show that CYP2D6*10 has the most clinical relevance in tramadol treatment. Other SNPs such as rs7439366 (UGT2B7), rs1641025 (ABAT) and rs1718125 (P2RX7) though significant have limited pharmacogenetic implications due to insufficient evidence. OPRM1 rs1799971, COMT rs4680 and ABCB1 (rs1045642, rs1128503, and rs2032582) need to be further explored in future for relevance in Asian populations.

Association between insulin-like growth factor 1 gene rs5742612 polymorphism and malignant tumor susceptibility: a meta-analysis

BACKGROUND

Malignant tumor is a serious threat to human health and life, which is a difficult problem in the world. Insulin-like growth factor 1 (IGF1) is an important mitotic factor in vivo. It usually acts in the way of autocrine and paracrine to control the proliferation, differentiation, and apoptosis of various cells, IGF1 has a strong mitotic and anti-apoptosis activity in malignant cells. Single nucleotide polymorphism (SNP) is an important part of individual genetic variation. A large number of studies have shown that IGF1 SNP associated with the risk of a malignant tumor may be an important biomarker for the diagnosis of malignant tumors. Therefore, the article will investigate the association between rs5742612 polymorphism of IGF1 gene and malignant tumor susceptibility.

METHODS

We searched for studies in five databases (PubMed, Embase, Web of Science, CNKI and Wanfang) regarding the association between IGF1 gene rs5742612 and malignant tumor susceptibility. Odds ratios (ORs) and the related 95% confidence intervals (CIs) were employed to assess the strength of the associations.

RESULTS

Ultimately this study identified seven articles that met the inclusion criteria, involving 2,581 cases and 2,445 controls. There was no significant correlation between IGF1 gene rs5742612 polymorphism and malignant tumor susceptibility [thymidine (T) vs. cytimidine (C), OR =0.99, 95% CI: 0.85-1.15, P=0.91; TC vs. CC: OR =1.03, 95% CI: 0.81-1.32, P=0.79; TT vs. CC: OR =0.92, 95% CI: 0.73-1.17, P=0.52; TT + TC =0.91; TC vs. CC: OR =0.97, 95% CI: 0.77-1.22, P=0.80; TT vs. TC + CC: OR =0.98, 95% CI: 0.81-1.18, P=0.83].

CONCLUSIONS

There was no significant association detected between IGF1 gene rs5742612 polymorphism and malignant tumor susceptibility.

Catechol-O-methyltransferase polymorphism Val158Met is associated with distal neuropathic pain in HIV-associated sensory neuropathy

BACKGROUND

Many of those aging with HIV suffer from distal neuropathic pain (DNP) due to HIV-associated sensory neuropathy (HIV-SN). Prior studies have linked chronic pain conditions to a variant of the catechol-O-methyltransferase (COMT), ValMet. This variant confers reduced enzymatic activity and results in higher synaptic dopamine levels. Here we examined the role of ValMet as a predictor of DNP in HIV-SN.

METHODS

In 1044 HIV-infected individuals enrolled in CNS HIV Antiretroviral Therapy Effects Research, an observational study across six US institutions, we characterized the relationship between ValMet and DNP in HIV-SN. Participants underwent neurologic examination and genotyping. Stratification into genetic ancestry groups was employed to eliminate bias due to genetic background.

FINDINGS

Of 590 participants with HIV-SN, 38% endorsed DNP, 24% reported nonpainful symptoms of neuropathy (paresthesia and numbness), and 38% were asymptomatic. Compared with asymptomatic HIV-SN, ValMet was associated with 2.3 higher odds of DNP. There were no increased odds of nonpainful symptoms. The association remained significant after controlling for other risk factors for DNP: lifetime diagnosis of depression, older age, ancestry, cumulative exposure to dideoxynucleoside antiretrovirals, diabetes, and nadir CD4. Stratified by genetic ancestry, the association between ValMet and DNP was significant in European and African genetic ancestry.

INTERPRETATION

ValMet may be a genetic marker for susceptibility to DNP in HIV-SN. Our findings support the notion that differences in pain processing mediated by COMT-related dopamine signaling play a role in susceptibility to DNP in HIV-SN. Because prior studies suggest that the COMT allele may influence dose-response relationships with opioid treatment, knowing COMT genotype could influence management.

Genetic Variants Associated with Cancer Pain and Response to Opioid Analgesics: Implications for Precision Pain Management

OBJECTIVE

To review the current knowledge on the association of genetic variants with cancer pain.

DATA SOURCES

Data-based publications and review articles retrieved from PubMed, CINAHL, and Web of Science, as well as an additional search in Google Scholar.

CONCLUSION

Genetic variability can influence differential pain perception and response to opioids in cancer patients, which will have implications in the optimal personalized treatment of cancer pain. More studies are warranted to replicate findings.

IMPLICATIONS FOR NURSING PRACTICE

Nurses are poised to educate patients on biomarker testing and interpretation and to use precision pain management strategies based on this information.

Pharmacogenomics of Medications Commonly Used in the Intensive Care Unit

In the intensive care unit (ICU) setting, where highly variable and insufficient drug efficacies, as well as frequent and unpredictable adverse drug reactions (ADRs) occur, pharmacogenomics (PGx) offers an opportunity to improve health outcomes. However, PGx has not been fully evaluated in the ICU, partly due to lack of knowledge of how genetic markers may affect drug therapy. To fill in this gap, we conducted a review to summarize the PGx information for the medications commonly encountered in the ICU.

The association between IGF1 gene rs1520220 polymorphism and cancer susceptibility: a meta-analysis based on 12,884 cases and 58,304 controls

Background

The rs1520220 polymorphism in the insulin-like growth factor 1 (IGF1) gene has been reported to affect cancer susceptibly in several studies. However, the results of the relevant studies are inconsistent. We conduct a current meta-analysis to investigate the association between rs1520220 and cancer susceptibly.

Methods

Three databases (PubMed, Embase, and Web of Science) were searched for studies regarding the relationship between rs1520220 and cancer susceptibly. Odds ratios (ORs) and the related 95% confidence intervals (CIs) were employed to assess the strength of the associations. A stratified analysis was performed according to cancer type, ethnicity, and quality score, and when results were obtained from no fewer than two studies, these results were pooled.

Results

There was no positive association between rs1520220 and overall cancer risk. However, the analysis stratified by ethnicity revealed that rs1520220 significantly increased cancer susceptibility in Asian populations (allele model OR = 1.10, 95%Cl = 1.00–1.21, p = 0.040; homozygote model OR = 1.22, 95%Cl = 1.01–1.47, p = 0.040; dominant model OR = 1.19, 95%Cl = 1.01–1.39, p = 0.033). No significantly association was detected in Caucasian populations. The analysis stratified by cancer type suggested that rs1520220 was not associated with susceptibility to breast cancer.

Conclusions

The results of our meta-analysis demonstrate that the role of IGF1 rs1520220 in cancer susceptibility varies by ethnicity and cancer type and that rs1520220 increases cancer susceptibility in Asian populations.

Electronic supplementary material

The online version of this article (10.1186/s12199-018-0727-y) contains supplementary material, which is available to authorized users.